MODERN REHABILITATION PROGRAMS IN PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER EXTREMITIES. - PowerPoint PPT Presentation

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MODERN REHABILITATION PROGRAMS IN PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER EXTREMITIES.

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MODERN REHABILITATION PROGRAMS IN PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER EXTREMITIES. Apkhanova T.V., Badtieva V. A. Federal State Institution Russian ... – PowerPoint PPT presentation

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Title: MODERN REHABILITATION PROGRAMS IN PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER EXTREMITIES.


1
MODERN REHABILITATION PROGRAMS IN
PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER
EXTREMITIES.
  • Apkhanova T.V., Badtieva V. A.
  • Federal State Institution Russian Scientific
    Center of Rehabilitation Medicine and Health
    Resort Science of the Ministry of Health and
    Social Development, Moscow, Russia.
  •  

2
In the general structure of a vascular pathology
lymphedema of lower extremities occupies
about 8-10 .
  • lymphedema suffer about 120 million persons
    in the World.(World Health Organization,2002).
  • In Moscow every tenth patient addressing for
    the specialised help to phlebologist, suffers a
    lymphatic odema of extremity.

3
-a feeling of heaviness -cosmetic
deformity-slight discomfort-repeated episodes
of infection (cellulitis and lymphangitis) -
malignant degeneration (Stewart-Treves syndrome)
-thickening of the skin-hardening of the
limb-leakage of lymph -massive swelling
(elephantiasis)These conditions considerably
decrease the quality of a life.
  • The problems for patients with Lymphedema

4
Etiological classification of Lymphedema
  • Primary lymphedema
  • hypoplasia lymphatics and lymph nodes
  • hyperplasia lymphatics
  • aplasia lymphatics and lymph nodes
  • Secondary lymphedema
  • damage or removal of regional lymph nodes through
    surgery
  • Radiation of regional lymph nodes
  • infection
  • after traumas or tumor invasion or compression.
  • vein stripping, peripheral vascular surgery
    (arterial reconstruction)
  • liposaction
  • burns, burn scar excision
  • insect bites

5
Treatment of Lymphedema of lower extremities
  • Conservative therapy
  • Operative treatment
  • Microsurgery
  • Surgical resection
  • Liposuction
  • recommendations about change of a way of life
  • skin care
  • medicamentous treatment (benzopyrones,
    antibiotics, and antifungal antibiotics)
  • compression by a low-stretch elastic stocking
  • ?omplex physiotherapy
  • pneumocompression

6
Physiotherapeutic treatment of Lymphedema of
lower extremities takes leading positions in
Lymphedema treatment
  • (2009 Consensus Document of the International
    Society of Lymphology).

7
clinical classification of lymphedema
(Savchenko T.V., Pokrovsky A.V., 2004)
  • I stages latent or subclinical edema
  • II stage - permanent (constant) edema
  • III stage - increase edema with subdermal
    fibrosis
  • IV stage - elephantiasis

8
Actions of various physical factors
  • stimulation of a lymphatic drainage
    (strengthening methods to stimulate lymph flow
    dynamics and lymphangion activity)
  • acceleration lymph transport
  • stimulation extralymphatic factors of lymph
    circulation (a muscular pump of a shin)
  • restriction lymph formation
  • normalisation of processes of microvascular
    circulation

9
The primary goals of Complex Decongestive
Physiotherapy (CDT)
  • 1. decrease edema
  • 2. increase lymph drainage from the congested
    areas
  • 3. reduce subdermal fibrosis
  • 4. improve the skin condition
  • 5. enhance patients functional status

10
In Center clinic we have developed and use
rehabilitation programs with the following
methods
  • magnetic stimulation,
  • magnetic laser therapy,
  • pulse matrix laser therapy,
  • cryotherapy,
  • pneumocompression,
  • balneotherapy (mineral baths and black mud),
  • thalassotherapy (algotherapy with cold seaweed
    application).

11
Complex Decongestive Therapy(on method Foeldi M.)
  • at 1 stage - a skin care, Manual Lymph Drainage
    (MLD) and bandaging of the limb by bandage of a
    short stretching, daily, physical exercises.
  • At 2 stage - (MLD) 2-3 times a week are carried
    out, elastic support garment with the high
    compression ( 4 classes of the compression), made
    on individual measures of the patient to order
    (MEDI, Germany).

12
  • Patient with Lymphedema III stage (Savchenko
    T.V., Pokrovsky A.V.'s classification, 2004)

13
At the I stage of Lymphedema
  • recommendations about change of a way of life
  • the elastic compression
  • courses of medicamentous therapy once a year
    (mainly in summer)
  • preventive and medical rehabilitation programs
    (magnetic stimulation, a pneumocompression,
    magnetic laser therapy, pulse matrix laser
    therapy, balneotherapy, thalassotherapy),

14
At the II stage of Lymphedema
  • recommendations about change of a way of life,
  • compression therapy,
  • courses of medicamentous treatment are spent 2
    times a year.
  • medical rehabilitation programs (a
    pneumocompression, magnetic laser therapy, pulse
    matrix laser therapy, magnetic stimulation,
    cryotherapy, balneotherapy, thalassotherapy,
    Manual Lymph Drainage and bandaging of the limb)
    are spent 2 times a year.

15
At the III stage of Lymphedema
  • to change of a way of life,
  • compression therapy,
  • Medical rehabilitation programs (a
    pneumo-compression, magnetic laser therapy,
    magnetic stimulation, pulse laser therapy,
    cryotherapy, balneotherapy, thalassotherapy,
    Manual Lymph Drainage and bandaging of the limb)
    are spent 2-3 times a year.
  • Medicamentous treatment is spent by courses for
    4-6 months and includes preventive appointment of
    the prolonged antibiotics for prevention of
    relapses of an erysipelatous inflammation.

16
At the IV stage of Lymphedema
  • patients accept surgical treatment with carrying
    out of conservative preoperative preparation and
    postoperative rehabilitation with use specified
    physiotherapeutic and medicamentous means.

17
Patiens with IV stage of Lymphedema
18
Patient with secondary Lymphedema II stage
(Savchenko T.V., Pokrovsky A.V.'s classification,
2004)
  • For treatment
  • After treatment

19
Development Physibalneotherapy of lymphedema
in Russia
  • Absence profile the special Lymphological centres
    in Russia is compensated by an existing wide
    network of branches of regenerative medicine and
    Health Resort establishments.
  • At stages of regenerative and Health Resort
    treatment patients with Lymphedema can spend
    effective complex not medicamentous therapy with
    application of a wide spectrum physiobalneotherape
    utic methods.

20
Conclusion
  • Creation of modern rehabilitation programs of
    regenerative treatment of patients with
    Lymphedema has allowed to raise considerably
    efficiency of conservative Lymphedema treatment
    and to create necessary base for development in
    Russia a physiotherapeutic direction in treatment
    Lymphedema of lower extremities.
  •  
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